Versatility of High-Velocity Nasal Insufflation (HVNI) in respiratory weaning: A case series demonstrating three distinct clinical objectives.

High-Velocity Nasal Insufflation (HVNI) is an advanced form of high-flow nasal therapy that delivers heated, humidified oxygen at high velocities through a small-bore nasal cannula, generating efficient extrathoracic dead space washout, mild positive end-expiratory pressure (PEEP), and enhanced patient comfort. While Non-Invasive Positive Pressure Ventilation (NiPPV) remains the reference treatment for acute hypercapnic respiratory failure, its use is frequently limited by patient intolerance. This case series presents three critically ill patients in whom HVNI was deployed during the respiratory weaning phase to achieve three distinct clinical objectives: (1) prophylactic stabilization to prevent post-extubation failure in a high-risk COPD patient; (2) rescue therapy for NiPPV intolerance with simultaneous airway clearance; and (3) bridging functional recovery during prolonged tracheostomy weaning. All patients achieved their targeted clinical endpoints without adverse events. These cases illustrate the clinical versatility of HVNI as an adaptable tool in the intensivist's armamentarium for individualized respiratory weaning strategies.